Monday, May 6, 2013

Deadly Drugs

Most Americans are aware that heart disease, cancers and strokes are the three leading causes of death in the United States today. They may not be aware of #4: the adverse effects of prescription medications. Every year, more Americans die from drug errors than from traffic accidents - forty people a day from prescription pain killers alone. And while nearly 40,000 of these deaths arise from behavior that might fairly be described as "drug abuse", nearly 750,000 perish is what can only charitably be called "mistakes".

To make matters worse, a recent study published in the Archives of Internal Medicine concluded that nearly 60% of the prescription medications taken by patients are not needed, and that 88% of patients reported feeling better when taking fewer or no drugs.

Let's take a look at just one type of prescription medication, the statins that are prescribed to lower cholesterol and which are the most prescribed, highest selling prescription drugs in the USA. One study published in the journal Pharmacotherapy found that 75% of people taking statins reported memory loss or other cognitive problems, and that fully 90% of them who stopped taking the medication showed rapid improvement. Other major side effects are well known and include muscle pain and weakness, neuropathy and an elevated risk of developing diabetes.

One of the less well known (among us non-experts anyway) measures of drug effectiveness is the so-called Number Needed to Treat (NNT). NNT is a measurement of how many people would need to take the drug in order for it to produce one beneficial outcome. Obviously the lower the number the better. For the popular statin drug Lipitor the NNT is 168. This means that 168 people would have to take Lipitor (for 4 years) to prevent one "cardiovascular event". Unfortunately, the risk for side effects can be as high as 1 in 10. That means 16 people will suffer the side effects so that 1 person may be helped. No doubt the fact that statin drugs produce an annual revenue of about $25 billion dollars in no way influences their popularity at the prescription pad. But to me these seem to be stunningly bad odds.

If you are taking two prescription medications a day, the odds of having a bad interaction between them is about 6%. If you are taking 5 per day, the odds skyrocket to about 50%.... 1 person in 2. With half (yes, half) of Americans taking at least one prescription drug (and nearly 1 in 5 taking 3 or more) this quickly produces large numbers of endangered people. We may be the most medicated nation on the planet.

I'll close with a personal story. About 10 years ago my mother, who was living in Florida and suffering from advancing Alzheimers disease, was no longer able to care for herself safely. As a result, she moved to California to be close to my brother. One of the first things he did was make an appointment with a neurologist, and on their first visit he took a list of the prescription medications that she was taking on a daily basis. She had prescriptions for diabetes, cholesterol, blood pressure, arthritis, degenerative heart disease and, of course, Altzheimers. Eight medications in all. When the doctor reviewed the list, she reacted with a combination of alarm and disbelief. Four of those medications were "mutually exclusive" - meaning that they had known interactions and were not prescribed together. Reducing my mothers medications to 3 per day produced an immediate, allbeit temporary, improvement in her mental and physical condition.

How could this happen? Because she was seeing four different "specialists", each of whom were prescribing medications without any idea what the others were doing. The doctors failed her, the pharmacist failed her, the insurance companies failed her, the healthcare system failed her and, to be fair, her family failed her.

The late Stephen Covey, in his book "First Things First", describes what he called "the rescue fantasy". "Most of us understand that a good percentage of the health problems we have are lifestyle-related. We live the way we want to live - little or no exercise, poor nutrition, burning the candle at both ends - and then when there is a problem we expect the medical profession to fix it. There's a pill for that."

There may be, but as more and more of us turn to medication to "fix" ourselves, we are starting to see that the cure may be more deadly than the problem.

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